Utilization Management Nurse Consultant

are, at the appropriate time, and at the appropriate location using designated criteria, while adhering to federal and state regulated turn-around times. This includes reviewing written and electronic clinical records. We are looking for someone who is highly motivated, detail-oriented, highly organized, and works well in a team environment.

Through the use of clinical tools and information/data review, the UM Nurse Consultant reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning, and works closely with facilities and providers to meet complex needs of the member.

Required Qualifications-Must have active current and unrestricted RN license in state of residence

-Minimum of 3 years of acute hospital clinical experience as an RN

-Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods of time

-A private designated workspace free of distractions and high-speed internet

-Must be willing and able to work Monday-Friday 8am-5pm EST with occasional weekend on-call and holiday rotation.

Preferred Qualifications-Candidate must possess strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues.

-Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

-Strong telephonic communication skills

-1+ years of Utilization Review experience

-1+ years of Managed Care experienceEducation

Associate's Degree Required

BSN preferredAnticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$29.10 - $62.32This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 11/08/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.